Patient Forms

We are also happy to offer you the option to download, print and complete forms to reduce wait times.
In order to view or print these forms you will need Adobe Acrobat Reader installed.  Click here to download it. 

New Patient Forms

 Demographic Information for 17 years and younger 
 Demographic Information for 18 years and older 
 Notice of Privacy Practices and Patient Consent Form 
 Family History Form 
 Authorized Adults Form 

Los Alamos Public Schools Forms

 Sports Form 
 State of New Mexico Concussion Form and Information Sheet 
 Food Allergy Action Plan Sheet 
 LAPS School District Forms Link 
 Return to Athletic Participation 
 Kindergarten Health Examination by Physician 
  Permission Form for Administering Medication in Schools  

ADHD Forms

 Vanderbilt Parent Forms 
 Vanderbilt Parent Forms Follow Up 
 Vanderbilt Teacher Forms 
 Vanderbilt Teach Forms Follow Up 

Asthma Forms

 Asthma Action Plan 
 Asthma Control Test (12 and over) 
 Asthma Control Test (4 to 11) 

Immunization Forms

 Vaccine Information Forms 
 Vaccine Administration Form 
 Vaccine Information Form - Spanish 

Other Forms

 Adolescent Depression Form 

Ages and Stages Questionnaires (English)


 1-3 mo. ASQ3-Questions 
 3-5 mo.ASQ3-Questions 
 5-7 mo.ASQ3-Questions 
 7-9 mo.ASQ3-Questions 
 9-11 mo.ASQ3-Questions 
 11-13 mo.ASQ3-Questions 
 13-15 mo.ASQ3-Questions 
 15-17 mo.ASQ3-Questions 
 17-19 mo.ASQ3-Questions 
 19-21 mo.ASQ3-Questions 
 21-23 mo.ASQ3-Questions 
 23-25 mo.ASQ3-Questions 
 28-31 mo.ASQ3-Questions 
 35-39 mo.ASQ3-Questions 
45-50 mo.ASQ3-Questions
57-66 mo.ASQ3-Questions 

Ages and Stages Questionnaires (Español)


 1-3 mo. ASQ3-Preguntas 
 3-5 mo. ASQ3-Preguntas 
 5-7 mo. ASQ3-Preguntas 
 9-11 mo.ASQ3-Preguntas 
 11-13 mo. ASQ3-Preguntas 
 15-17 mo.ASQ3-Preguntas 
 17-19 mo.ASQ3-Preguntas 
 28-31 mo.ASQ3-Preguntas 
 35-39 mo.ASQ3-Preguntas 
 45-50 mo.ASQ3-Preguntas 
 57-66 mo.ASQ3-Preguntas 

Ages and Stages Activities Forms


 1-4 mo. Activities for Infants 
 4-8 mo. Activities for Infants 
 8-12 mo. Activities for Infants 
 12-16 mo. Activities for Infants 
 16-20 mo. Activities for Toddlers 
 20-24 mo. Activities for Toddlers 
 24-30 mo. Activities for Children 
 30-36 mo. Activities for Children 
 36-48 mo. Activities for Children 
 48-60 mo Activities for Children 
 60-66 mo. Activities for Children